Allogeneic stem cell transplantation for chronic myeloid leukemia-status in 2007

Whereas until 2000 allo-SCT was the recommended treatment for all new patients with CML who were eligible on grounds of age and donor availability, approaches to initial therapy have changed very substantially since the introduction of imatinib mesylate. Today topical questions are (1) Should any newly diagnosed patient receive SCT as primary therapy? (2) How should imatinib failure be defined? (3) Should a patient who has failed imatinib but is still in chronic phase be offered an SCT or further treatment with a 'second-generation' TKI? (4) Would prior treatment with imatinib or concomitant delay to transplant adversely affect the subsequent results of allo-SCT? (5) Once the decision to proceed with allo-SCT is taken, how exactly should this be performed? (6) If a patient relapses after allo-SCT, how should he/she be treated? These questions will be addressed, but definitive answers may not yet be possible.